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Auditor General releases report on eChart

WINNIPEG – Auditor General Norm Ricard today released his report, eChart Manitoba, which includes 15 recommendations.

In Manitoba, personal health information is stored on a number of electronic systems, each with its own clinical objective. Launched in 2010 by eHealth Manitoba, eChart pulls information from many of these systems, giving authorized health care providers quick and easy access to their patients’ medical histories. Authorized users include physicians, nurses, administrative staff and other health-care professionals.

The audit examined whether eHealth was properly managing the risks that could result in eChart’s intended benefits not being realized, in unauthorized access, and in gaps to its availability. “The quality of health care provided to Manitobans can be greatly facilitated when authorized health practitioners have quick and reliable access to required patient medical information,” said Ricard.

The Auditor General noted most of the baseline clinical information identified in eChart’s 2007 vision can now be accessed through the system, such as drugs dispensed from pharmacies, lab test results, diagnostic imaging reports and immunization records. However, the report notes that much of the additional clinical information identified in the 2007 vision is not yet available through eChart. This clinical information includes blood type and allergy profiles, as well as emergency room diagnosis and discharge summaries, medical clinic visits and homecare reports.

The audit further noted that important initiatives to integrate additional clinical sources into eChart have been repeatedly delayed. “The 2007 vision for eChart – which was a 5-year vision – has not been updated,” said Ricard. “As such, it is not clear whether it remains the intended future state. A clear desired future state can help inform planning decisions.”

The audit found that a number of performance indicators were in place to help monitor eChart’s usage, privacy and availability, but that none were in place to monitor progress in achieving eChart’s intended benefits. Intended benefits include improved quality, safety and timeliness of care; increased access to and management of care in remote communities; reduced duplicate and unnecessary tests, and rescheduled visits from undelivered results; and more efficient and effective collaboration with specialists and other healthcare providers.

“When setting strategic and annual IT funding priorities for eHealth, decision makers should be informed of the impact potential funding decisions will have on eHealth’s ability to increase the amount of information available through eChart,” said Ricard. “Decision makers should also be informed of the impact continued information shortfalls may have on the number of active eChart users, and on the extent to which intended benefits are being realized.”

The Auditor General also found several weaknesses in eChart’s access controls that could compromise the confidentiality of Manitobans’ personal health information.

The audit found more than 87% of current eChart users could access the personal health information of any Manitoban. “We’re concerned that many sites may be defaulting to providing users with full access regardless of whether they have a need to know,” Ricard said.

The Auditor General also found that eHealth’s monitoring of user activities had gaps, most notably that few automated user activity triggers were used. “Given the high percentage of eChart users with full access, the need to effectively monitor for inappropriate activity is heightened,” said Ricard.

The report notes some former users continued to have access to eChart almost 2 years after termination. “Users no longer employed by the organization – or who otherwise should no longer have eChart access – should have their access privilege removed in a timely manner,” said Ricard.

The Auditor General noted eHealth had good practices in place to backup and restore eChart’s data; however, eHealth’s disaster recovery plan was not complete. “A sound disaster recovery plan is important because it reduces recovery time and costs following a significant disruption,” said Ricard.

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